This Week in JAMA FREE

TRANSFUSION AND OUTCOMES IN ACUTE CORONARY SYNDROME

Patients with ischemic heart disease and anemia may be at increased
risk of adverse outcomes, but there is limited evidence that blood transfusion
is associated with improved survival. Rao and colleaguesArticle analyzed
data collected in 3 large trials of patients with acute coronary syndromes
who developed bleeding, anemia, or both during hospitalization to examine
the association between blood transfusion and 30-day mortality. In analyses
adjusted for in-hospital events such as bleeding and invasive procedures,
they found a significantly increased risk of mortality in patients receiving
transfusions. In an editorial,Article Hébert
and Fergusson discuss the implications of this finding for clinical decision
making.

RACE AND ETHNICITY IN TIMING OF REPERFUSION THERAPY

Nonwhite patients with acute myocardial infarction are reported to have
longer waiting times from hospital arrival until reperfusion therapy compared
with white patients, but the reasons for this are not clear. Bradley and colleaguesArticle used national data to examine race and ethnicity
differences in time to reperfusion in relation to sociodemographic factors,
insurance status, clinical characteristics, and hospital features. They confirmed
the treatment delay for nonwhite minorities but found that a substantial portion
of the treatment time disparity was accounted for by the hospital in which
care was received rather than treatment differences by race and ethnicity
within the hospital. In an editorial,Article Winker
discusses the proper definition and analysis of race and ethnicity in biomedical
research.

HORMONE THERAPY AND RISK OF VENOUS THROMBOSIS

Postmenopausal hormone therapy is known to increase the risk of venous
thrombosis (VT). Two articles in this issue of JAMA further
understanding of this association. First, Cushman and colleaguesArticle report
their analyses of data from the Women’s Health Initiative Estrogen Plus
Progestin trial, which included assessment of the interaction of hormone
therapy with other demographic and clinical risk factors for VT. The authors
found that hormone therapy increased the risks of VT associated with age,
overweight or obesity, and factor V Leiden. In a second article, Smith and
colleaguesArticle compared the risk of first VT among
women taking esterified estrogen or conjugated equine estrogen with or without
progestin vs nonusers of hormone therapy. They found that current use of conjugated
equine estrogen but not esterified estrogen was associated with an increased
risk of VT compared with nonuse, and the risk was increased with concomitant
progestin use.

CVD PROFILE IN YOUNG WOMEN AND MORTALITY RISK

Cardiovascular risk factors measured in young adulthood are related
to long-term cardiovascular and all-cause mortality in young men and middle-aged
men and women, but the relationship for young women is not known. Using data
from a prospective cohort study, Daviglus and colleagues examined the relationship
of coronary heart disease (CHD) and cardiovascular disease (CVD) risk factors
measured at baseline in women aged 18 to 39 years to CHD, CVD, and all-cause
mortality at an average of 31 years’ follow-up. They found that women
classified as low risk at baseline by virtue of favorable measures of blood
pressure, serum cholesterol, body mass index, diabetes, and smoking status
had significantly lower mortality in all 3 categories than the other women.

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